The American journal of emergency medicine
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Most patients at low to intermediate risk for an acute coronary syndrome (ACS) receive a 12- to 24-hour "rule out." Recently, trials have found that a coronary computed tomographic angiography-based strategy is more efficient. If stress testing were performed within the same time frame as coronary computed tomographic angiography, the 2 strategies would be more similar. We tested the hypothesis that stress testing can safely be performed within several hours of presentation. ⋯ Patients who present to the ED with potential ACS can safely undergo a rapid diagnostic protocol with stress testing.
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Cardiac arrest is a daunting medical emergency. The aim of the present study was to assess whether the combination of adrenaline and glucagon would improve initial resuscitation success, 48-hour survival, and neurologic outcome compared with adrenaline alone in a porcine model of ventricular fibrillation. ⋯ In this porcine model of prolonged ventricular fibrillation, the addition of glucagon to adrenaline improves hemodynamics during resuscitation and early postresuscitation period and may increase survival.
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Comparative Study
Performance comparison of lung ultrasound and chest x-ray for the diagnosis of pneumonia in the ED.
The aim of our study was to assess the potential of bedside lung ultrasound examination by the attending emergency physician in the diagnosis of acute pneumonia. ⋯ These results exhort to promote the use of thoracic ultrasound in the first-line diagnosis of pneumonia.
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To determine the ability of prehospital end-tidal carbon dioxide (ETCO₂) to predict in-hospital mortality compared to conventional vital signs. ⋯ Of all prehospital vital signs, ETCO₂ was the most predictive and consistent for mortality, which may be related to an association with metabolic acidosis.
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Case Reports
Massive cerebrovascular air embolism during posttraumatic cardiopulmonary resuscitation.
Air embolism is known to be a complicating factor in several clinical settings, including thoracic, cardiovascular, and neurosurgical operations; central line placement; and penetrating thoracic and cranial trauma. There are, however, only few case descriptions for cardiopulmonary resuscitation massive cerebral air embolism, and the frequency of this supposedly rare complication is unknown. Computed tomography is useful for showing cerebral air embolism. In this report, we present a 16-year-old adolescent girl with cerebrovascular air embolism on computed tomographic examination after a posttraumatic cardiopulmonary resuscitation and discuss the reasonable mechanisms of cerebrovascular air embolism.